International Metastatic RCC Database Consortium (IMDC) Risk Score
The International Metastatic Renal-Cell Carcinoma Database Consortium’s (IMDC) prognostic model to predict survival of metastatic kidney cancer patients has become the standard model used in clinical trials to categorize patients into favorable, intermediate, and poor risk. In 1999, Memorial Sloan-Kettering developed an early model. In 2009, Daniel Heng from Tom Baker Cancer Center, Calgary, AB, developed a new set of variables that included neutrophil count. Upon validation in a kidney cancer trial (see “External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model” in Lancet Oncology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144042/), Heng’s model came closest to predicting death after a two-year period compared a number of other models. It is now the standard model called the IMDC model.
IMDC is used in clinical trials to, first, categorize, select, and evaluate patients based on risk status. It can also be used to select candidates for clinical trials, course of treatment selection, and counseling patients on next steps. An example of its use occurred in 2018, when the results of a trial using the combination ipilimumab and nivolumab versus sunitinib showed benefits to intermediate and poor risk patients but not favorable risk ones, who did better on sunitinib. The FDA approved the immunotherapy combination for only intermediate and poor risk patients.
Before Treatment
| Measure | Score |
|---|---|
| Treatment Time Less than one year from time of diagnosis to systemic therapy | 1 / 0 |
| + | |
| Performance Status <80% (Karnofsky: cancer symptoms affecting normal activities) | 1 / 0 |
| + | |
| Hemoglobin < lower limit of normal (Normal: 120 g/L or 12 g/dL) | 1 / 0 |
| + | |
| Calcium > upper limit of normal (Normal: 8.5 to 10.2 mg/dL) | 1 / 0 |
| + | |
| Neutrophil > upper limit of normal (Normal: 2.0 to 7.0×10⁹/L) | 1 / 0 |
| + | |
| Platelets > upper limit of normal (Normal: 150,000 to 400,000) | 1 / 0 |
| = Total Score |
Risk Categories
by Total Score (above)
| Category | Total Score |
|---|---|
| Favorable Risk | 0 |
| Intermediate Risk | 1 to 2 |
| Poor Risk | 3 to 6 |
For an explanation of Karnofsky Performance Status, go to KPS on this website.
